Provider Demographics
NPI:1306224597
Name:BANDY, STEPHANIE (APN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BANDY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:IGWEBUIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:3229 BROADWAY AVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-2512
Mailing Address - Country:US
Mailing Address - Phone:219-531-3500
Mailing Address - Fax:219-427-0434
Practice Address - Street 1:3229 BROADWAY AVE.
Practice Address - Street 2:SUITE 205
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-2512
Practice Address - Country:US
Practice Address - Phone:219-531-3500
Practice Address - Fax:219-427-0434
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005449A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN651990018Medicare Oscar/Certification